Bloody Hell - Angelina Jolie

[LtEveDallas]

Have just seen this on the news:

BBC News

Poor woman. Must be terrifying to be given 'odds' like those. What a terrible decision to have to make, but the right one I think.

[uwaga]

Whatever you think of her as an actor or 'celebrity' does not detract from the fact that she is a woman who has suffered loss - of her mother, far too young, and now of her breasts.

She has been brave and dignified in sharing her experience and has used her extraordinary platform to raise awareness of an issue that affects many other women. I for one am grateful to her.

tiredteddy - all the best to your mum, my fingers are crossed for her too.

[LarkinSky]

I didn't know she was famous for her breasts and lips either. Isn't that Katie Price?

Those women could hardly be more different. Angelina Jolie is more a humanitarian than an actor these days anyway. And she's the embodiment of dignity. I luffs her too :-)

[showtunesgirl]

Known for her lips and breasts?

Sorry, I know her for her Oscar winning performance in Girl, Interrupted.

[Copthallresident]

Great as it is that she has come out publicly with her story and doubtless it will be a story that helps some women faced with genetic risk, and also has helped raise awareness of the scandal of the cost of genetic testing , why are we making this woman into a saint. the media is now full of coverage featuring words like brave, gruelling and inspiring as if her experience of breast surgery is somehow worse and more profound than all the other millions of women who have mastectomies with or without reconstruction, many of whom go through far more "gruelling" experiences. It is almost as bad as Breast Cancer Awareness week when every celebrity with a pulse gets themselves on to the covers of magazines with tales of their "cancer hell" . Thankfully Katie Price so surpassed the bounds of sensitivity moaning about her poor scarred breasts that those who were struggling to come to terms with scarred breasts finally ensured we never have to endure her exploiting the awareness bandwagon again.

She isn't a saint, she is a beautiful woman who makes use of her looks to make a living and to get involved in raising awareness of issues such as the problems facing countries in Africa and Asia ,and now women who have a genetic predisposition to Cancer. So far so good.

However her own actions to actually address those issues have been hamfisted. I posted a link to an article earlier which describes why people who know anything about the problems in Cambodia are extremely sceptical about the "good" she has done there, naively falling into the trap set by an unscrupulous woman who ran a scam of selling children under the guise of an "orphanage" (Maddox has living parents, but like most people in Cambodia they are so poor that they are vulnerable to this sort of scam) and of her foundation being exploited by former members of the Kmer Rouge. Why I wonder did she not invest in one of the amazing experienced NGOs out there who are very much aware of the pitfalls instead of setting up a foundation with her and Maddox's name attached?

Sadly one of the issues about the coverage of Breast Cancer in the press is that it never reflects the reality that we really do not understand the vast majority of the risk. Genetic risk, along with other known risk factors is responsible for a tiny proportion of the risk everyone (men get breast cancer too) has of getting this disease. Yet the Daily Mail and Telegraph like nothing better than running a headline that infers that rising rates of cancer are the result of women drinking too much or having babies too late or not breastfeeding. As my oncologist says the vast majority of women who walk through her door with BC did everything right and that coverage is insulting and misleading. The risk with those stories and this over indulgence in AJs story is that people get misled into thinking that if they don't have a genetic risk and they make really rather fundamental changes to lifestyle, giving up drink, having babies young etc they will reduce their risk, which it will do only slightly and maybe take their eye off the boob ball in terms of checking them.

[HesterShaw]

Great post, Cop.

[beginningtoend]

Yes, agree with above - thank you Copthallresident.

Those testing positive for the inherited BRCA 1 or 2 gene are faced with the dilemma of progressing to prophylactic surgery - double mastectomy and possibly removal of ovaries, or living in the shadow of knowing breast and/or ovarian cancer is likely to develop (calculated risks are individual to each person).
With such a high calculated risk as A.J. faced, the clinical decision - although ultimately hers - was academic. To not have surgery, given her odds would, in all probability, resulted not only in her developing these diseases, but also having the aggressive forms which, tragically, remain rapidly life-limiting despite progress in treatment.

The UK has now fallen behind other European countries with regard to cancer survival rates and the Department of Health etc (in the last 18 months) has identified that improving survival rates as well as quality of life has to be top priority and a number of initiatives have been put in place to address same.

The majority of breast cancer cases will not be of the inherited type (e.g. BRCA gene as AJ has). In as much as we know about these (majority) cases, there are what are known as associated factors - more than best guesses - as to what increases breast cancer chances. For some time it has been referred to a disease linked to 'more affluent' societies, in that those with a higher fat diet (and more recently alcohol has been added to the list) become higher risk. The same goes for not having children or having children later in life and not breast-feeding.' Lifestyle' choices do have an impact on breast cancer rates, in the same way that 'lifestyle choices (high meat intake, low fibre diet) can impact on bowel cancer rates.

These increased risk factors are likely to enter the public debate more and more as there is a real push to educate the public as to how we can reduce our risks of developing these vile diseases. They should never be used a stick to beat ourselves (or others up with), but help us to make informed choices. The risk factors of high fat diet, smoking, pregnancy/childbirth in later years, not breastfeeding have been known to cancer scientists for many years. I was involved in a low fat diet study at the Royal Marsden Hospital in the late 1980's, (i.e. 25 years ago) because we'd begun to look at the association between high animal fat/hydrogenated fats and breast cancer risk increase). Links with alcohol intake identified more recently.

As for AJ. I do admire the way in which she has handled and publicised her experience. So what if she has promoted the body beautiful in the past? Her objectification of the female form (e.g. Tomb Raider) happened - it's in her past. She has inherited a faulty gene and in her case the risk of developing and dying prematurely from aggressive cancer was so high that she had to face the unenviable decision of major surgery right away and in the future. She is a human being first and foremost. Thank goodness we have genetic marker/predictors that can show our risk. But god help those of us that are then faced with the information/decision.
Jade Goody chose to video diary her progress up until her death. Her choice and I'm not judging it. Angelina Jolie chose to keep that information out of the public domain until her harrowing treatment was complete (or at least the first stage of it). I have every admiration for her - if someone who has made her living from her beautiful physical looks has made choices where she has put her children and life expectancy first, then publicised it in a very dignified way after the event, I thank her for that. It brings to the forefront the debates we need to have about this ugly disease.

I have worked with and treated people (women and men) who've developed breast cancer. The vast majority look back through their lives to see if there was something they could have done differently to have prevented the disease. Guilt is unhelpful. We don't consciously make lifestyle choices thinking 'this is going to effect my health and possibly/probably kill me, therefore I'll do it'. The risks between smoking and lung (and other cancers) has been proven beyond any doubt, yet people still smoke. This shows how complex the bigger picture is. If we drank alcohol in moderation (or not at all), ate high fibre, veg and fruit rich diets, cut out processed foods, refined sugar and high animal fats. exercised and socialised regularly - yes, people in western society would be much healthier. But..... it's that human being thing again! We're human and fallible. I like a cream cake/glass of wine or two as much as the next person. A dear friend of mine (and brilliant scientist and medical doctor) died in January aged 49 years. She leaves a grieving husband (ironically a cancer specialist) and four children between the ages of 14 and 5. She died from breast cancer. By the time the familial pattern of breast and ovarian cancer in her family became apparent (and therefore triggered her to have the gene tests) it was already 'too late'. Yes, she had the BRCA gene and when she had her mastectomies her breast tissue was found to already be cancerous and was also found in her lymph nodes. I am not saying for one moment that her life was any more worthy than the next's person, just because of what she did. Three of her children are female. They will now have to face the dilemma of being tested and, if positive, choosing whether or not to have their breasts and ovaries removed. Vile, vile, vile.

There are things we can learn from this and Angelina's situation. First, the majority of breast cancers are not of the inherited kind, but - if you think there is a pattern in your family (near relatives - sister, grandmother, mother etc), then please talk to your GP (asap) about being tested. For the rest of us, let's recognise/accept that there are lifestyle choices that increase our risk (even though the active 'ingredient' or cancer trigger hasn't specifically been identified). My friend realised - too late - that delaying having children until her late thirties/early forties (as many of us are doing) contributed to upping her risk. Had she known, earlier in her life that she had the faulty gene, she made quite clear she'd have had her children earlier. At the same time she refused to feel guilty because she didn't know she had the BRCA 1/2 gene when she was having her family. There's nothing to be gained from going over things we have already done after the event. That's why so many oncologists will reassure women (and men) that their lifestyle didn't make a difference.

As we become more aware of the risks and associated factors, so our 'choices' become more informed (and more complex). If you want evidence and best practice related information about all cancers, may I suggest that you look at the MacMillan website (macmillan.org.uk) where risks, myths, facts etc can be found. The information is presented in a clear and yet sensitive way.

Let's work together to eradicate this bloody awful disease. Yes, treatments and survival rates are much improved, but breast cancer deserves nothing less than to be totally annihilated.
It needs an input from all of us for that to be achieved.

[Copthallresident]

Agreed beginning to end* but you miss out the hormonal components of risk. A lot of the known factors relate to their impact on lifetime exposure to Oestrogen, including diet since body fat increases levels of Oestrogen. What is also known is that anything that increases your exposure to Oestrogen will increase your risk and we are also exposed to Oestrogen in drugs and in the environment, one of the reasons postulated for the increase in hormonal Cancers in men too (Prostate etc) My Consultant and Oncologist believe that actually the currently unknown component of risk (which last time I spoke to them was 95%) is probably a complex interplay of genetic predisposition (and we are far from knowing all the genes that increase risk, I have several friends who have multiple family incidences of BC but have tested negative for known genes but have been advised they are almost certainly genetically predisposed but by an unidentified gene) and a vulnerability to exposure to hormones that is being increasingly challenged by our increased exposure to hormones resulting not just from lifestyle but also environmental pollution and drugs.

[beginningtoend]

Copthallresident.
Again, I wholeheartedly concur. My BC likely to have been influenced by me being overweight (although a vegetarian since my teens) and therefore being exposed to higher circulating levels of eostrogen over prolonged period of time. BC for the most part is a disease affecting older women and as yet we don't know how many women, when coming to the end of their lives, die from an unrelated illness/condition, whilst also having undiagnosed breast cancer.

We recognise the complex interplay is a given (I too have specialised in oncology), and I agree with your earlier post re: avoiding the blame game, because it is never as straightforward as just avoiding this and doing/not doing that. Again, I concur with you (and the evidence-base is increasing) re environmental pollutants. My sister still insists on buying 'out of date' water in plastic bottles which she drinks while at the gym (such irony). The amount of pollutants leaching out of the plastic into the water worries me. Hormones in the urine of women who take contraceptive and HRT pills finding their way into our domestic water concerns me. My sister knows these things and chooses to continue drinking 'out of date' water, knowing that the dates relate to safety margins for deteriorating water quality held in plastic containers as much as plastic degradation. I wouldn't knowingly drink that water....

The 'lifestyle' choice thing is in many ways a confounding variable. I didn't 'choose' to remain childless; I was never able to carry my babies to term. I knew - in the academic sense - that this increased my risk of BC exponentially. I missed out on the protective element that breastfeeding has been credited with. I was a post-doc doctor before I embarked on having a family. I'm an overweight, childless woman, who planned and tried to have a family with my husband after my thirty fifth birthday.
For me, smoking is out. HRT will be out. I moderate my alcohol intake. I know that I'd be increasing my risks should I choose to do otherwise. I keep an eye on the latest NICE recommendations.

My husband is also a medic and epidemiologist and we discuss what may well be a ticking time bomb with regard to the obesity epidemic and the extent to which this may result in a sharp upward trend in breast cancer, just as we are seeing with diabetes type 2.

As our lives become ever more complex and we make ever more sophisticated choices, we often do so without knowing or fully understanding the knock-on effect or consequences. We can't possibly know them all when it comes to BC. We can educate ourselves and others on current thinking/research and emerging patterns, and take all of this into account. My dear friend lived through her cancer experience and ultimately lost her life to cancer, whilst her husband, a consultant oncologist struggled with his personal/professional views and responsibilities.We knew of the risk factors and the latest advancements in treatment (the three of us met while working at the Institute of Research). With all that effort and combined knowledge (and manipulating the system to ensure she had nothing less than first class treatment throughout - and yes -everyone should be entitled to same), her cancer recurred and she died within four years of her diagnosis. A non-smoking, marathon-running vegetarian (all pre-diagnosis) who fed her children only organic foods, she nevertheless did talk candidly to friends and colleagues about unknowingly increasing her risk ratio by starting a family in her late thirties and having children in her forties.

Debunking the myths and promoting the facts we have to hand are the responsibility of all health care workers. As members of the public we can all do our bit too. I feel for you as I do for me - we are women linked by our diagnosis, and I for one despise this damn disease and can only imagine you do too. I can't undo the things I've already done, but I can learn from them and use this knowledge to help others. People, as patients, often ask me what I'd do in their situation. While I'd never say 'you must do this' I can and do talk through different choices and their associated risks.

I don't claim to have the answers, but I do deal in evidence and facts as we currently understand them. Prevention and, if that fails, early diagnosis - together with appropriate treatment - are key to preventing/containing this disease. Eradication is a mammoth, some would say impossible challenge. We can take preventative measures and we can improve on early diagnosis and treatment. In the UK we are failing - when compared with western societies across the world - to improve on those three key areas. The UK is falling down the league tables and this unacceptable.Understanding why this is happening and redressing the balance asap has to be our top priority.



(As an aside, I abhor the Daily Mail and all its sensational nonsense. For different reasons I intensely dislike the Telegraph too!)

[beginningtoend]

'Institute of Research' should have read 'Institute of Cancer Research'. Sorry

[HesterShaw]

This "delaying children" thing is really bothering me, which I do feel a little silly about, but it's bothering me nonethless. I've been trying to have a baby since I was 34 and I'm now 38. It feels like one more thing to be worried about :(

[RonaldMcDonald]

Hi copthall
I disagree with your view that anyone on here is suggesting that AJ is a saint. She has a past and future like anyone else. I am interested when people feel the need to denigrate others at times when their negative commentary would seem inappropriate to the rest of the population. Interesting POV and interesting that you felt the need to repeat it. I hope that it has satisfied something within you to do so.

I don't think that your earlier link actually showed anything particularly bad regarding her foundation tbh. Looked like the link was speculative and pointless and rather beside the point.

Can you link to the fact that her son Maddox had been adopted whilst having living parents? I was unaware that that was true.

Thanks

[Copthallresident]

ronald my pov related as much to the eulogising in the press as on here, though use of the words inspiring, brave, gruelling etc on here too. Point is that AJs situation needs to be put in some sort of perspective and mine arrived at from fact I have had extensive experience of womens' experience of breast cancer and am involved in the study of Asia and have colleagues who are involved and know a great deal about what happens on the ground in Cambodia, where it is considered she sadly missed the opportunity to make a real difference in a country that is struggling to recover from the effects of the genocide of its most skilled and educated people. You have your perspective too which you are entitled to, based on? Of course press has moved on now and all the AJ coverage now fish and chip paper but all those perceptions of celebrity and cancer reinforced , regardless of how they relate to reality. If you want to understand the implications of these attitudes for women newly diagnosed there is a thread on here where women who have been there support those who are newly diagnosed not only to come to terms with the reality but the added burden of society's perceptions of cancer and of how you should react to a diagnosis.

hester Firstly Breast Cancer is still relatively rare, 1 in 10 lifetime risk, much smaller that you will get it whilst pre menopausal when it is hard to treat. Secondly the point I was making is that the effect of known risk factors factors on your risk is tiny and most of that accounted for by familial risk, having babies early will only reduce your risk very marginally and may well be counteracted by all the stress of doing so before you are ready it really isn't a basis for making changes to lifestyle that would be life changing in a negative way. Things like diet and exercise are easy and generally positive anyway but using BC risk as a stick with which to beat women into living their lives in a certain way is neither positive or justified. What I would say though is that as part of the investigations into infertility they will test your hormone levels, my level of oestrogen was sky high, one of the problems, but no one warned me of the longer term implications, an increased risk of BC . It may be worth asking about. Of course if the levels are not high that means less risk .

[Copthallresident]

ronald if you google on the adoption of AJs children there is a lot of coverage of the fact the he, and her Vietnamese and African children all have living mothers. However all from Daily Mail like sources so I would not trust them but I would trust this source , www.theage.com.au/articles/2004/01/08/1073437411857.html

[Punkatheart]

Sorry but there is no need to bring in other elements when we are discussing a woman's breast cancer and reconstruction. If a friend was dying of lung cancer, would you suddenly start discussing some dubious scheme she had been involved in?

This should be a discussion about cancer.

She is a brave woman and trying to reduce her but other thrusts of criticism is to me, somewhat pointless and irrelevant.

[Copthallresident]

punk just responding to all people down the thread who were commenting on her amazing charitable works, based on the strongly held views of people I know. It is ok to eulogise but not to point up the reality?

[Copthallresident]

Also as I pointed out before she doubtless is as fed up of being labelled brave as all the other women I know who have faced BC.

[Punkatheart]

I have lymphoma. Brave is fine. It's the battle stuff which pisses off cancer patients most.

I just think the focus is needed on the subject in hand.

Celebrities will face criticism whatever they do but this is specifically about breast cancer. It would be lovely to have direct responses from women with the disease and their perspective. Has AJ helped? Let's talk about the disease and judge the person less.

[Lighthousekeeping]

Her adoptions have got nothing to do with it and hat article doesn't prove anything anyway.

[Copthallresident]

And as a woman with Breast Cancer I pointed out her story and successful reconstruction and reduction in her risk will doubtless provide comfort to women faced with a familial risk and the decisions she faced. So far, so good. For the greater numbers of us faced with an actual Breast Cancer diagnosis, then the perspective adopted in this coverage has raised all sorts of issues.

• The fighting, brave rhetoric that the Press leads society in adopting. As I pointed out upthread a young mumsnetter summed it up in starting up a Facebook meme to try and counteract all the ones that appear with that rhetoric - it can't be repeated enough
  
  "(and I do blame the press for always saying how someone is 'bravely fighting' cancer. Cancer happens to people and they deal with it - there's no going into battle. )
  
  All the people sharing "inspirational" pictures about people "fighting" cancer and some people "losing the battle", have you ever had cancer? I'm sure you mean well but it's not a personality contest, you don't live because you're tougher or stronger or braver than anyone else. People don't die from it because they didn't "fight" hard enough. If there is a battle to be fought it is between science and nature, and the patient is just the battleground. Some people will have all the treatments and take every possible supplement and do everything by the book and they will still die. They haven't failed in any way."
  
  

• The focus on breasts and beauty instead of on women being enabled to go on and lead fulfilling lives with or without them. Many of us can't have reconstruction, and the process of coming to terms with not having a breast, or indeed deciding whether to submit to "gruelling" surgery and it's long term consequences when faced with a serious illness is not helped by the Presses focus on celebrities like AJ and Michelle Heaton (and before them Anastasia, Kylie - though I felt she at least proved a celebrity can expose the reality of Breast Cancer treatments with dignity and without attention seeking) emerging with perfect boobs. I was never that bothered about my breasts so it wasn't hard to come to terms with, it really doesn't look that bad, I could look in the mirror post surgery and chemo bald and one boobed and see it was still me, everything I value about myself still in tact. However I know many women whose psychological burden was increased by that emphasis.
  

• The eulogising, as if her experience, actually a lot less "gruelling" than that faced by many diagnosed with Breast Cancer, is somehow more profound and gruelling than anyone else's, has really pissed off a lot of women who have Breast Cancer.
  

• The press generally as well as in this case do not represent the issue of risk in a balanced way. The number of women at risk of Breast Cancer as a result of these known genes, and all the other known risk factors, is a small proportion of all the women at risk. AJ's dilemma is real but actually rare. There is a danger that women think, as I did, that because they have no family history, eat a healthy diet, exercise, breastfeed etc. they have little risk and they take their eye off the ball but actually that only improves your chances by a small margin.

[Copthallresident]

BTW Punka You would be very welcome in the Tamoxifen thread, it is inclusive of all women who have had or face any sort of Cancer Dx "gruelling" or otherwise. Quite a lot of black humour and focus on the normal and getting on with life but also the support of shared experience. Obviously we are all different and cope differently but it is one form of support....

[Punkatheart]

Thank you Cop. Black humour I can relate to. Asked about my health recently I boasted that I never get colds. I am on Interferon - which seems to prevent 'em. 'This cancer is a real cure for colds,' I laughed.

I will get my coat.

[Copthallresident]

Oh yes the benefits of Cancer treatment are undersold, they should market chemo as a spa treatment, you lose weight, get clearer skin and your hair grows back luscious and curly.......

[Punkatheart]

Yes my hair is very thick now. Mind you I had to be bald about three times but it got there in the end.

[RonaldMcDonald]

copthall

IMO you are heaping the entire bullshit that surrounds cancer at AJ's door.
I think you have been incredibly insensitive and inappropriate.

As a website run by women I was so surprised to read anything like this on here. I thought that there would have been respect for her honesty.

AJ has nothing to do with talking about cancer being a fight etc or any of that tripe.

The link you posted was nonsense and at best insinuation regarding her charitable work in Cambodia and there is absolutely no evidence to show Maddox has living parents.
Also you had no reason to speak about these things

Imagine if people discussed you and your illness always saying 'well I have less time for her as she has always been so so beautiful'
Or 'well someone once told me that she could have been better at her job'
or 'oooo did you hear there was something dodgy about her children'

Grim

How the press have reported her surgeries is not how she has. She was, like most with cancer or staring at cancer, straight to the point.
She had a reconstruction. That doesn't belittle the experience of those who haven't or who won't in the future. Nor do it say that anyone values them less.
Do you level that criticism on other people who have had reconstructions?

What I hear is bitterness and meanness focussed on a woman who lost her mother to breast cancer and when faced with her odds of dying the same way had a double mastectomy to try to remain on the planet for her children.
Trying to blame her for all cancer ills is nonsense and inappropriate.
Trying to slur her when she is being positive and hopeful and forthright is wrong and speaks more about those who are doing it that her.